Hepatitis C-related Hepatocellular Carcinoma Research Articles

Hepatocellular carcinoma

Hepatitis C infection is associated with the development of hepatocellular carcinoma, and progress has been made in a number of areas. Transgenic mice lines expressing the hepatitis C core protein develop hepatic steatosis, adenomas, and hepatocellular carcinomas, with no significant hepatitis or fibrosis. This implies that hepatitis C can lead directly to malignant transformation. A new lesion, irregular regeneration, has been described in chronic hepatitis C infection and is associated with a 15-fold increase in the relative risk of developing hepatocellular carcinoma. A minority of patients with hepatitis C-related hepatocellular carcinoma have intense lymphocytic infiltration of the cancer, a feature associated with a better prognosis. Several studies have confirmed the association between large cell dysplasia and hepatocellular carcinoma. However, large cell dysplasia may not be a premalignant lesion and instead may be a marker for premalignant alterations elsewhere in the liver. Oral contraceptives previously have been linked to an increased risk of hepatocellular carcinoma. A large multicenter European case-control study has shown minimal increased risk of hepatocellular carcinoma with use of steroidal contraception. Tamoxifen had shown promise in the management of advanced hepatocellular carcinoma. However, a randomized placebo-controlled study of 477 patients with hepatocellular carcinoma found no benefit from tamoxifen. In a preliminary study, however, octreotide has shown improved survival and quality of life in patients with advanced hepatocellular carcinoma. Finally, interferon treatment continues to be linked to a reduced risk of hepatocellular carcinoma in patients with hepatitis C. These studies generally are not randomized, and a randomized prospective study is required to address this issue.

Hepatitis C-related Hepatocellular Carcinoma: Prevalence Around the World, Factors Interacting, and Role of Genotypes

Hepatocellular carcinoma is the most frequently occurring cancer world-wide and is responsible for approximately one million deaths each year (1). It is frequently found in patients with chronic liver disease resulting from infection with hepatitis C virus, and as many as 170 million or more people may be infected with this virus (2). Epidemiologic studies have identified the risk of hepatocellular carcinoma in patients infected with the hepatitis C virus and the routes of transmission of the disease (3-5), but it is unclear what factors interact with the virus to increase an individual's risk for carcinoma. The most plausible explanation presented thus far is that the virus causes chronic necroinflammatory hepatic disease with vigorous regeneration, fibrosis, and eventual cirrhosis (3). The World Health Organization has estimated that approximately 80 percent of patients with acute hepatitis C viral infection will go on to develop chronic hepatitis; of these, 20 percent will develop cirrhosis and 1-5 percent will progress to hepatocellular carcinoma (2). The purpose of this review is to determine which risk factors interact with hepatitis C infection among persons who develop hepatocellular carcinoma. Studies have shown that the roles of hepatitis B and C viruses in hepatocarcinogenesis vary considerably among populations. However, the independent role of hepatitis C virus in the genesis of hepatocellular carcinoma is poorly understood. Some conditions implicated as being predisposing, or etiologic factors for the risk of hepatocellular carcinoma, include older age, male sex, excessive alcohol consumption, blood transfusion, chronic liver diseases, cirrhosis, and dietary exposure to aflatoxin (6-10). An important next step

A comparison of the surgical results in patients with hepatitis B versus hepatitis C—related hepatocellular carcinoma

To assess the differences in the surgical results between patients with hepatitis B- and hepatitis C-related hepatocellular carcinoma (HCC), the operative outcomes of 30 patients with hepatitis B surface antigen (HBsAg)-positive (the B-HCC group) and 96 patients with hepatitis C antibody (HCVAb)-positive (the C-HCC group), who had undergone hepatic resection from 1989 to 1993, were compared. The mean age of the patients in the C-HCC group was higher than that in the B-HCC group (61.7 years vs. 57.0 years, P < .05). The C-HCC group demonstrated both a greater decrease in liver function and a larger enhancement of inflammatory changes in the liver under a pathological examination (the current rate of active hepatitis: 69% vs. 27%, P < .001). There was also a higher incidence of total postoperative complications in the C-HCC group (60% vs. 37%, P < .05); however, regarding each individual complication, the rate was similar between the two groups. Two of the six patients with postoperative hepatic failure in the C-HCC group died. The mortality rate in the C-HCC group was 2%, but no operative death was encountered in the B-HCC group. The crude survival and the disease-free survival rates at 5 years were similar, 61.8% and 46.2% in the B-HCC group and 52.8% and 23.2% in the C-HCC group, respectively. The patterns of recurrence were also similar in both groups. The pathological features of HCC were similar between the two groups. In conclusion, the surgical results between the two groups were almost identical. However, because of the reduced liver function along with the enhancement of inflammatory changes in the liver, surgeons should therefore be more careful when determining operative indications and conducting the follow-up after surgery, especially for the C-HCC patients.

A comparison of the surgical results in patients with hepatitis B versus hepatitis C-related hepatocellular carcinoma

To assess the differences in the surgical results between patients with hepatitis B- and hepatitis C-related hepatocellular carcinoma (HCC), the operative outcomes of 30 patients with hepatitis B surface antigen (HBsAg)-positive (the B-HCC group) and 96 patients with hepatitis C antibody (HCVAb)-positive (the C-HCC group), who had undergone hepatic resection from 1989 to 1993, were compared. The mean age of the patients in the C-HCC group was higher than that in the B-HCC group (61.7 years vs. 57.0 years, P < .05). The C-HCC group demonstrated both a greater decrease in liver function and a larger enhancement of inflammatory changes in the liver under a pathological examination (the current rate of active hepatitis: 69% vs. 27%, P < .001). There was also a higher incidence of total postoperative complications in the C-HCC group (60% vs. 37%, P < .05); however, regarding each individual complication, the rate was similar between the two groups. Two of the six patients with postoperative hepatic failure in the C-HCC group died. The mortality rate in the C-HCC group was 2%, but no operative death was encountered in the B-HCC group. The crude survival and the disease-free survival rates at 5 years were similar, 61.8% and 46.2% in the B-HCC group and 52.8% and 23.2% in the C-HCC group, respectively. The patterns of recurrence were also similar in both groups. The pathological features of HCC were similar between the two groups. In conclusion, the surgical results between the two groups were almost identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis C-related hepatocellular carcinoma. Prevalence and significance

Hepatitis C-related hepatocellular carcinoma. Prevalence and significance